MARIA FERNANDA VILLAVICENCIO JIMENEZ MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

ACTIVE

Business

Title

First Name

MARIA

Middle

FERNANDA

Last Name

VILLAVICENCIO JIMENEZ

Business Name

MARIA FERNANDA VILLAVICENCIO JIMENEZ MD

Original Issue Date

08/29/2024

Effective Date

08/29/2024

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63110

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/04/2024